Medical Student University Of Birmingham Birmimgham, England, United Kingdom
Rationale: The impact of chronic conditions such as epilepsy on quality of life (QOL) is well recognized. Poor QOL is typically associated with uncontrolled seizures and the side effects of polypharmacy1. However clinical experience suggests that many patients with epilepsy (PWE), in spite of attaining good seizure control, report fears regarding the ongoing risk of seizures. This in turn impacts on quality of life. This adjustment response has been identified with other chronic conditions such as heart failure2 but is not well recognized in PWE. We characterized the extent and nature of adjustment symptoms in PWE in a tertiary outpatient centre, the Queen Elizabeth Hospital, Birmingham UK.
Methods: The Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and Patient weighted Quality of Life in Epilepsy (QOLIE-10-P) were given to patients to self-report prior to their consultation. Those lacking capacity to complete the questionnaires independently were excluded from data collection. Results: Seventy-four completed questionnaires were analyzed (35 excluded as either non-epileptic attack disorder or incomplete questionnaires). Forty (54%) patients were depressed (NIDDIE >15) of whom 13 (32.5%) had good seizure control of ≤1 seizure/ month. There was no correlation between the combination (presence of levetiracetam or zonisamide) or the number of antiepileptic medications and mood state. Fifty-five (74.3%) had reduced QOL (QOLIE 10P >25), despite 20 (36.3%) of this group having good seizure control (≤ 1 seizure/month). Thirty-one (77.5%) of the depressed patients experienced reduced QOL. Twenty-four (70.5%) of the non-depressed patients also reported reduced QOL. The factors most commonly reported as impacting on QOL were impaired ability to perform daily activities (17%), impaired mental activity (16%) and concern about emotions (15%). Twenty-two (29.7%) of the cohort reported being ‘very afraid’ of having a seizure in the next four weeks, although more than a third of this group are currently seizure free. PWE struggle with low mood and adjusting to living with a chronic condition, often in spite of attaining good seizure control with minimal medications There are a number of factors which contribute to impaired quality of life beyond just seizure management. Assessing quality of life in a clinical setting is challenging, as mood state alone is a poor proxy measure. All PWE would potentially benefit from early psychological support to reduce their fears around the risk of future seizures and help to maintain their sense of role in the wider community. Conclusions: PWE struggle with low mood and adjusting to living with a chronic condition, often in spite of attaining good seizure control with minimal medications There are a number of factors which contribute to impaired quality of life beyond just seizure management. Assessing quality of life in a clinical setting is challenging, as mood state alone is a poor proxy measure. All PWE would potentially benefit from early psychological support to reduce their fears around the risk of future seizures and help to maintain their sense of role in the wider community. Funding: Please list any funding that was received in support of this abstract.: None
